Drainage and feeding cannulae



Aug. 18, 1964 M. E. JASCALEVICH DRAINAGE AND FEEDING CANNULAE Filed Oct.21, 1960 INVENTOR MARK) E. JASCALEVICH ATTORNEY UCTIDN United StatesPatent 3,144,868 DRAINAGE AND FEEDING CANNULAE Mario E. Jascalevich, 43560th St., Weehawiren, NJ. Filed Oct. 21, 1960, Ser. No. 64,088 4 Claims.(Cl. 128350) The invention relates to improvements in surgical devicesof the type suitable for post-operative treatment of portions of thegastro-intestinal tract.

Treatment following certain types of gastrointestinal surgery requiresthat both aspiration and feeding be accomplished at affected areas.Aspiration serves to remove excess or undesirable fluids; the supply ofnutritive fluids is necessary to provide nourishment and promotehealing. It has been proposed to utilize the nasal route for drainageand feeding. Nasogastric intubation however, has resulted in thedevelopment of lesions of the upper respiratory and digestive tracts,producing ulcerative and later stenosing esophagitis. Moreover, manyindividuals, because of age, emotional make-up or otherwise, cannottolerate nasogastric intubation. As a result, and to obviate theproblems and disadvantages attending nasogastr-ic intubation, the moreusual technique resorted to in recent years has been a temporarygastrostomy.

A known technique for a gastrostomy, more particularly a gastrectomy,involves the use of a device comprising a double-lumen tube in the formof a single body or unit through which suction and feeding take place.The lumens are disposed in fixed, side-by-side relation throughout theirlengths. Where, as in a Billroth II, the application of suction to drainis necessary in the gastric or aiferent loop, coupled with feeding tothe eiferent loop, it is impossible to aspirate the one area and feedthe other with the aforementioned prior art device. Also, in the firstweek following a gastroenterostomy, it is imperative that the afferentloop be kept clean and empty, and obstruction or kinking of the loopmust be prevented. At the same time, nutritive fluid must beindependently supplied at another and differently located area; namely,the efferent loop.

In accordance with the invention, a device suitable for temporarygastrostomy is provided which permits aspiration and jejunal feeding tobe accomplished simultaneously at the spaced areas where respectivesuction and feeding are required. The nasal route is avoided.Independent suction from the stomach and/ or the afferent anastomoticloop is coupled with the injection of feeding solution into the efferentloop. The device is particularly adapted for use in connection with aBillroth II and a gastroenterostomy. The afferent loop, which isparticularly prone to obstruction, is prevented from being obstructed.The device of the invention, by permitting gastric suction andintra-duodenal feeding to be accomplished simultaneously and at theseparate areas which selectively require independent suction andfeeding, is also suitable for use in connection with a Billroth I and anesophago-gastric resection.

These, and other advantages of the invention will be apparent from thefollowing description of a preferred embodiment of the invention, takenin conjunction with the drawing, in which:

FIG. 1 is a side elevational view, partly broken away and in section, ofa device made in accordance with the invention;

FIG. 2 is a diagrammatic view showing the device of the inventionemployed in a Billroth II; and

FIG. 3 is a diagrammatic view showing the device of the invention asemployed in a gastroenterostomy.

Generally, a surgical device made in accordance with the invention,comprises a drainage conduit and a separate feeding conduit. Theconduits or tubes, which are of flexible, resilient material, aremaintained in adjoining, parallel relationship along the upper portionsof their lengths. The upper ends of the conduits are adapted forrespective connection to a suitable suction means and a source of foodsupply. The lower portions of the con-- duits are unconfined or free toprovide separate limbswhich are laterally movable for independentpositioning in selected areas. Such relationship of the conduits permitsthe freely movable limb portion of the drainage conduit to be positionedin the afferent loop so that suction may be applied to such area to keepit clean, while permitting the freely movable limb portion of thefeeding conduit to be positioned in the efferent loop for the supply ofnutritive fluid thereto. The presence in the afferent loop of thesection of flexible, resilient tubing having a tendency to straightenout to its normally linear position serves to prevent undesirablekinking or obstruction of the loop in which such section or limb of thedrainage conduit is located.

In greater detail, and referring to FIG. 1 which illustrates a preferredembodiment of the invention, an elongate, tubular body 10 is providedfor the support of a drainage conduit or tube 12 and a feeding conduitor tube 14. The tubes 12 and 14 are of smaller diameter than the tubularbody 10. In fact, the total diameter of both the drainage and feedingtubes is somewhat less than the internal diameter of the tubular bodywithin which they are disposed and supported. The tubular support body10 and the drainage and feeding tubes 12 and 14 are preferably ofelastomeric material, such as surgical-grade rubber.

The drainage and feeding tubes extend and are maintained generallyparallel to one another for the portions of their lengths within thetubular body. The upper end of the drainage tube 12 is in communicationwith the exterior of the tubular body. Similarly, the upper end of thefeeding tube 14 is in communication with the exterior of the tubularbody. As shown, the uppers ends of the drainage and feeding tubes areprovided with obliquely offset portions 16 and 18, respectively, whichextend through openings 20 and 22 formed in the wall of the tubularbody. Preferably, and as illustrated, the obliquely offset portions areformed to provide increased diameters to facilitate respectiveconnection of the tubes to sources of suction and food supply. Theflared diameters also assist in providing a suitable seal at theopenings 20 and 22 in the body wall, fitting snugly in the openingswhere the tube portions extend through the wall. To identify the tubesfor the user of the device, the exposed ends may be imprinted with asuitable legend as indicated on FIG. 1.

The drainage and feeding tubes 12 and 14, while confined adjacent oneanother for the portions of their lengths within the tubular body 10,extend downwardly and exteriorly of the tubular body, passing out of thetubular body through an opening 24. From a viewing of FIG. 1, it will beapparent that the portions of the drainage and feeding tubes, designated12a and 14a, respectively, which extend exteriorly beyond the lower endof the tubular body are not connected to one another or confined, sothat they are free for independent, lateral movement with respect to oneanother. Accordingly, the tube portions or limbs 12a and 14a can beindependently positioned at respective, desired areas of treatment.

The drainage or aspirating tube 12 is provided along its free,unconfined limb portion 12a with a series of spaced inlet apertures 26.The limb portion Ma is provided at its distal end with a dischargeaperture 28. If desired, a second discharge aperture may be providedinwardly of the distal end.

In order to assist in holding the device in position, an

inflatable annulus or balloon 30 is provided adjacent the juncture ofthe free, lower limb portions 12a and 14a and their confined upperportions. As shown in FIG. 1, the inflatable balloon preferablycomprises an annular band of thin, elastic material which is formed toextend in spaced, surrounding relationship with respect to the lower endof the tubular body 10. The thin, annular band is preferably formed withthe edges thereof molded integrally with the wall of the tubular body. Alongitudinally extending conduit 32 is related to the thin, annular bandto permit a fluid to be conveyed to the area between the band and theadjoining wall of the tubular body to inflate the band or balloon. Asshown, the wall of conduit 32 is molded integrally with the wall of thetubular body for most of its length, and has an outlet 34 to theinflatable balloon 3E The opposite end of the conduit 32 is incommunication with a nipple-like extension 36 of the body 10, and has anopening at its end 38 for connection to a suitable fluid source appliedunder pressure, and inflation of the balloon. preferably provided with abend 40 to facilitate tying off the extension after the pressure sourcehas been removed, thereby maintaining the annular band or balloon ininflated condition; The extension 36 may be molded integrally with thetubular body or, as shown, the extension may be made as a separate pieceand cemented to the tubular body at 42.

The device of the invention is used in the following manner. After agastrostomy has been performed by the usual technique, the drainage tubelimb 12a is passed into the segment of the bowel where suction isdesired; that is, the stomach, duodenum or afferent loop, as the casemay be. The feeding limb 14a is introduced in the duodenum or theefferent loop, depending on the situation. The distal or lower end ofthe tubular body 10 is then passed inside the stomach, and the balloonis inflated. The gastrostomy is completed, as with a Stamm technique,while the proximal end of the tubular body 10, including the flaredportions 16, 18 and the portion 36, is positioned outside of theabdomen. With the drainage tube end 16 connected to a suitable source ofsuction, such as a Wangesteen machine, and the feeding tube end 18 isconnected to a suitable drip feeding device, the device is suitablyfixed to the skin edge of the incision. If desired or necessary, theaspirated fluids can be injected through the feeding tube after beingaseptically collected.

FIG. 2 shows the device of the invention as employed in connection witha Billroth II. The limb 12a of the drainage conduit is positioned toapply suction in the afferent loop, and the limb 14a is positioned inthe efferent loop to supply nutritive fluid thereto.

FIG. 3 shows the use of the device as employed with a gastroenterostomyin connection with which the drainage limb 12a is similarly positionedfor gastric afferent loop suction, and the limb 14a is positioned tosupply nutritive fluid to the efferent loop.

The afferent loop has a tendency to kink and thereby become obstructed.The resilient limb 12a, in addition to removing fluid from such area,and because of its tendency to return to its normal straight or linearcondition, acts to prevent such kinking.

While the device of the invention is particularly effective inconnection with a Billroth II gastrectomy, and when used after agastroenterostomy, the device is also suitable to furnish gastricsuction and intraduodenal feeding for a Billroth I and a gastro-esophagoresection.

While a preferred embodiment of the invention has been illustrated anddescribed, it will be apparent that various modifications and changesmay be made. For example, while the drainage and feeding conduits havebeen shown as single, continuous, separate tubes, it is within the scopeof the invention to have these tubes confined within the tubular bodyand extending below the lower end of the The extension 36 is tubularbody no further than to provide separate nipples. Whereupon, separatetube sections or limbs of a length required by the exigencies of theindividual case may be secured to such nipples. It will be understoodthat this, and other modifications and changes may be made withoutdeparting from the spirit and scope of the invention as sought to bedefined in the following claims.

I claim:

1. A device suitable for use in connection with a gastrostomy comprisinga flexible drainage conduit of elastomeric material, a flexible feedingconduit of elastomeric material, means for maintaining said conduitsadjoining one another and in parallelism along the upper portions oftheir lengths, the upper ends of said conduits being adapted forrespective connection to suction means and a source of food supply, thelower portions of said conduits being free for independent positioningin selected areas, an inflatable balloon, means for maintaining saidballoon adjacent the juncture of said upper and lower portions of thedrainage and feeding conduits and surrounding the conduits, and a thirdflexible conduit of elastomeric material associated with and maintainedsubstantially parallel to said drainage and feeding conduits incommunication with said inflatable balloon.

2. A device suitable for use in connection with a gastrostomy comprisinga flexible tubular body, a flexible.

drainage tube within said body, a flexible feeding tube within saidbody, the upper ends of said tubes being in communication with theexterior of said body for respective connection to suction means and asource of food supply, a flexible conduit within said body having theupper end thereof in communication with the exterior of said body, aninflatable balloon, means for maintaining said balloon adjacent to andsurrounding the lower end of said body, the lower end of said conduitbeing in communication with said inflatable balloon, said drainage andfeeding tubes each being of a length to extend exteriorly beyond thelower end of said body for free independent positioning in selectedareas.

3. A device suitable for use in connection with a gastrostomy comprisinga flexible tubular body, a flexible drainage tube within said body, aflexible feeding tube within said body, the upper ends of said tubesbeing in communication with the exterior of said body for respectiveconnection to suctionmeans and a source of food supply, a flexibleconduit within said body and formed integrally therewith, an inflatableballoon, the upper end of the conduit being in communication with theexterior of said body and the lower end of said conduit being incommunication with said inflatable balloon provided adjacent the lowerend of said body, said balloon being formed integrally with said body,said drainage and feeding tubes each being of a length to extendexteriorly beyond the lower end of said body for free independentpositioning in selected areas.

4. A device as set forth in claim 3, wherein the tubular body, thedrainage tube, the feeding tube, the conduit and the inflatable balloonare of elastomeric material.

References Cited in the file of this patent UNITED STATES PATENTS617,016 Harris Jan. 3, 1899 2,587,910 Shulman Mar. 4, 1952 2,831,487Tafilaw Apr. 22, 1958 2,936,760 Gants May 17, 1960 FOREIGN PATENTS758,357 France Jan. 15, 1934 OTHER REFERENCES J.A.M.A., vol. 158, No.15, Aug. 13, 1955, A New Technique Combining Suction and Feeding for Usein Gastric Surgery, page 1361 required.

2. A DEVICE SUITABLE FOR USE IN CONNECTION WITH A GASTROSTOMY COMPRISINGA FLEXIBLE TUBULAR BODY, A FLEXIBLE DRAINAGE TUBE WITHIN SAID BODY, AFLEXIBLE FEEDING TUBE WITHIN SAID BODY, THE UPPER ENDS OF SAID TUBESBEING IN COMMUNICATION WITH THE EXTERIOR OF SAID BODY FOR RESPECTIVECONNECTION TO SUCTION MEANS AND A SOURCE OF FOOD SUPPLY, A FLEXIBLECONDUIT WITHIN SAID BODY HAVING THE UPPER END THEREOF IN COMMUNICATIONWITH THE EXTERIOR OF SAID BODY, AN INFLATABLE BALLOON, MEANS FORMAINTAINING SAID BALLOON ADJACENT TO AND SURROUNDING THE LOWER END OFSAID BODY, THE LOWER END OF SAID CONDUIT BEING IN COMMUNICATION WITHSAID INFLATABLE BALLOON, SAID DRAINAGE AND FEEDING TUBES EACH BEING OF ALENGTH TO EXTEND EXTERIORLY BEYOND THE LOWER END OF SAID BODY FOR FREEINDEPENDENT POSITIONING IN SELECTED AREAS.